Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2005 / Cilt: 31 - Sayı: 1
Management of early urinary leakage after radical cystectomy
- Pages
- 31–35
- DOI
- —
Abstract
Introduction: Invasive transitional cell carcinoma of the bladder is often treated by radical cystectomy and urinary diversion. With the routine use of soft silastic stents, the rate of urinary leakage is reported to be 2% to 8.3%. And thus the aim of this study is to evaluate our clinical approach to urinary leakage occurring in the early postoperative period in patients with radical cystectomy and urinary diversion. This article formulates a treatment outline emphasizing an initial conservative approach that offers optimal management of urinary leakage after urinary diversion. Materials and Methods: Hospital records of a total of 212 patients who underwent radical cystectomy and urinary diversion between January 1998 and May 2004 were retrospectively reviewed. We spesifically focused on the patients with urinary leakage in the early post-operative period (within the first 30 days after the operation). The patients with urinary leakage were evaluated in two groups as patients with open surgical intervention (group 1) and patients followed-up conservatively with placement of bilateral nephrostomy tubes (group 2). Both groups were evaluated in terms of clinical parameters such as mortality (any death within the first 30 days or before discharge home), morbidity and duration of hospitalization. Treatment of complications related to urinary leakage after urinary diversion in the early post-operative period was defined as conservative (including percutaneous intervention), or requiring open surgical reoperation or abdominal exploration. Results: Urinary leakage in the early post-operative period occurred in 17 (8.9%) of the patients. 10 patients with ileal conduit (58.8%), 6 patients with ureterosigmoidostomy (35.3%) and 1 patient with orthotopic bladder (5.88%) had urinary leakage. Five patients (%29.4) underwent early open surgical intervention without any change in the urinary diversion type. The remaining 12 patients were followed-up with bilateral nephrostomy tubes. 3 patients in surgically treated group were lost because of intraabdominal sepsis due to intestinal leakage to abdominal cavity. Mortality rate in group 1 was 60% (3), while no patients was lost in group 2. 3 patients (25%) in group 2 had urosepsis managed without any significant morbidity. Hospital stay was significantly higher in group 1 compared to group 2. Conclusion: Most often the management of patients with urinary leakage after urinary diversion is conservative, involving adequate drainage and placement of percutaneous nephrostomy tube, continued close suction drainage adequate nutrition, avodiance of sepsis and close monitoring. Despite the placement of nephrostomy tubes, patients with peritoneal irritation findings and urosepsis should be managed surgically.
Özet
Bu çalışmanın amacı kas invazif mesane kanseri sebebiyle radikal sistektomi - üriner diversiyon yapılan hastalarda erken dönemde gelişen üriner kaçağa yaklaşımımızı değerlendirmektir. Ocak 1998-Mayıs 2004 tarihleri arasında mesane kanseri tanısıyla radikal sistektomi yapılan 212 hasta hastane kayıtlarının retrospektif olarak incelenmesi yoluyla değerlendirildi. Ameliyat sonrası erken dönemde üriner kaçak saptanmış olan hastalara klinik yaklaşıma göre açık cerrahi girişim yapılanlar (grup 1) ve iki taraflı nefrostomi yerleştirilerek konservatif olarak takip edilenler (grup 2) olarak iki ayrı grupta değerlendirildi. Her iki grup mortalite, morbidite, hastanede kalış süresi gibi klinik parametreler açısından karşılaştırıldı. Ameliyat sonrası erken dönemde üriner kaçak görülen olguların %58.8 (10)'ine ileal loop, %35.2 (6)'sine üreterosigmoidostomi, %5.88 (l)'ine ortotopik mesane yapılmıştı. Üriner kaçak sebebiyle 5 (%29.4) hastaya erken cerrahi girişim uygulanırken bu hastaların hiçbirisinde üriner diversiyon değişikliği yapılmasına gerek duyulmadı. Bu grupta 3 hasta barsak materyali kaçağı ve buna bağlı batın içi sepsis nedeni ile kaybedildi. Açık cerrahi girişim yapılan ve iki taraflı nefrostomi tüpü ile konservatif olarak takip edilen hastalardaki erken dönem mortalite oranları sırasıyla %60 ve %0 olarak saptandı. İkinci grupta 3 hastada (%25) urosepsis gelişti. Erken dönem üriner kaçağı olan hastalarda, iki taraflı nefrostomi yerleştirilmesine rağmen peritoneal irritasyon bulguları ve batın içi sepsis görüldüğünde erken dönemde açık cerrahi girişim yapılmalı, diğer hastalarda ise konservatif yöntemler tercih edilmelidir.